Category Archives: AMM 2011, Volume 57, Number 6

The Elastographic Aspect of Liver in Pediatric Patients with Hepatopathies and Malignities Versus Healthy Children

Mărginean Oana1, Baghiu Maria Despina1, Brînzaniuc Klara2, Mărginean Claudiu3, Chinceșan Mihaela1, Pitea Ana Maria1

1 Clinic of Pediatrics, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Anatomy and Embriology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Liver injury in context of chronical diseases, including malignacies, obesity, viral hepatitis, drug-related hepatotoxicity is an important concern for practicing pediatricians. The usual (biochemical) parameters for liver assessment prove to be now insufficient. Nowadays there is a high interest for finding non-invasive methods of hepatic evaluation, as an alternative to liver biopsy. Elastography fills a gap, provi-ding information on the degree of hepatic fibrosis.
Objective: Real-time elastographic assessment of liver tissue in correlation with biochemical parameters in children with hepatopathies and malignancies versus healthy children.
Material and method: Between September 15, 2010 and March 15, 2011 we conducted a prospective study in the Ist Pediatric Clinic Tîrgu Mureș, Romania, including a group of children with various malignancies under/after chemotherapy, a group of children with liver diseases (drug-related hepatotoxicity, obesity, hepatitis) and a control group composed of children with normal biochemical parameters. We assessed the liver tissue elasticity, expressed as SWV (shear wave velocity) on elastography, biochemical parameters, then statistical correlations were performed.
Results: Comparing SWV-values between the three groups, higher speeds were found in groups with liver damage after chemotherapy and those with hepatopathies (p=0.04). Aspartate transaminase (AST, IU) and alanine transaminase (ALT, IU) levels were different in a statistically significant manner between the three groups (p=0.0006 and 0.0002 respectively). In the after-chemiotherapy group significant correlations were obtained between elasticity and AST (p=0.0001).
Conclusions: In children with liver damage, SWV (which is correlated with the degree of liver fibrosis) increase in parallel with transaminases.

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The Study of the Maxillary Growth and Primary Fetal Palate Through Multiplanary Three-Dimensional Ultrasound – Skeletal Rendering

Mărginean C1, Brînzaniuc Klara2, Rozsnyai Klára1, Mühlfay Gh3, Horváth Karin4, Mărginean Oana Cristina5

1 Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Anatomy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Otorhinolaringology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Department of Ophtalmology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
5 Department of Pediatrics, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: This study aims to suggest a new technique for the ultrasound assessment of fetal facial bones at the end of the first trimester and the beginning of the second gestational trimester.
Material and method: The study was conducted over a period of 6 months, between October 2010 and March 2011, on a number of 52 acquired fetal 3D volumes, stocked by the same operator, on fetuses with normal echo structure, from unique pregnancies. The cohort of 52 fetuses had the gestational age between 12–14 weeks. Ultrasonographies were made at 16–17 weeks and 22–24 weeks. The methodology for the evidence of primary palate and maxillary alveolar used a 3D multiplanary ultrasonography technique “Face Reverse View” with Maxi IP and Skeletal Rendering.
Results: Practically, in all volumes the presence of the jaw with alveolar ridge and primarly palate as single, uninterrupted structure has been documented.
Conclusions: The usage of Skeletal Rendering can provide further information at the level of the cranial bone, especially in the first half of pregnancy.

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Seminoma’s Architectural Variants, Immunophenotype and Differential Diagnostic

Loghin Andrada1, Preda O1, Nicolae Alina2, Aneiros J2, Borda Angela1, Nogales FF2

1 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pathology, San Cecilio University Hospital, Granada, Spain

Introduction: Although rare, representing only 1–2% of all tumours in man, testicular germ cell tumours (TGCT) are the overwhelming majority (98%) of testicular neoplasms among male patients between 15 to 40 years of age. Due to their increasing incidence and the characteristically young targeted population, they become a problem of public health in some developed countries. Classically, TGCTs are classified in three main groups: classical seminoma, non-seminomatous germ cell tumours (pure or mixed) and the spermatocytic seminoma. As SS is a very rare tumour, with a benign evolution, in practice the main differential diagnosis to be made is between seminoma and non-seminomatous tumours. Distinguishing these two categories is essential as the prognostic and the therapeutic approach is very different: if radiotherapy is the main treatment for seminoma, for non- seminomatous tumour a cisplatin based chemotherapy will be proposed.
Material and methods: This study proposes a morphologic and immunohistochemical evaluation of an important number of seminomas emphasising their unusual architectural features.
Results: The majority of the seminomas (46 cases), either pure or as a component of non-seminomatous germ cell tumours, had a solid architecture. We identified syncytiotrophoblasts cells in only one case in conventional stain and 11 cases were associated with a scattered intertubular spread. Eighteen cases showed unusual patterns: tubular-trabecular (9 cases), microcystic areas (5 cases) and 4 seminomas had focal nuclear pleomorphism. Areas of focal or extensive fibrosis and hemosiderin laden macrophages were identified in 4 cases. IGCNU, conventional seminomas and all the unusual architectural variants of seminoma had the same immunoprofile: positivity for PLAP and negativity for AFP and CD30.
Conclusions: Our study confirms the high architectural variability of seminomas, with unusual histological patterns like intertubular, tubular-trabecular, microcystic and pleomorphic. In the great majority of cases, the diagnosis of seminoma relies on the histological pattern in conventional stain. Only few cases may be prone to be diagnostically challenging, including tumours with unusual patterns. In these circumstances, the use of a panel of antibodies is mandatory for a correct diagnosis.

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Pancreas Injury in Shock

Kovács Judit1, Jung J2, Gurzu Simona2, Azamfirei L1, Copotoiu Sanda-Maria1, Copotoiu Ruxandra1, Szederjesi J1

1 Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Morphopathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: The causes of acute pancreatitis are well known, and although enzymatic injury is the main factor in its development, pancreatic ischemia due to profound hypoperfusion in cardiogenic or hypovolemic shock patients can be an important etiological factor. The aim of our study was to analyse the histological alterations of the pancreas in patients dying after shock, to study the presence and severity of pancreatic injury.
Material and methods: We studied the morphological alteration of the pancreas, in patients who died after cardiogenic or hypovolemic shock, hospitalized in intensive care units in the County Emergency Hospital Tîrgu Mureș, between 2007–2009.
Results: We examined the structure of the pancreas of 117 patients, 20 showed acute hemorrhagic pancreatic necrosis on autopsy. None of the patients showed typical clinical and laboratory signs for acute pancreatitis. The common findings in these patients were prolonged and severe hypotension, leucocytosis, hyperglycemia and hypocalcemia.
Conclusions: Pancreatitis can occur in patients with shock, due to ischemic injury of the pancreas. It is difficult to diagnose it because clinical signs are altered by the severity of the underlying disease or by analgo-sedation commonly used in intensive care units. We therefore recommend to consider the possible development of acute pancreatitis in patients with shock, in patients with prolonged hypotension, leucocytosis, hypocalcemia, even in the absence of characteristic clinical symptoms and hyperamylasemia.

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Atrial Fibrillation In Acute Myocardial Infarction

Macarie C, Năstase-Melicovici D

Institute of Cardiovascular Diseases, Clinic of Cardiology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Although atrial fibrillation (AF) is a common complication of acute myocardial infarction (MI), patients characteristics and association with outcomes remain poorly defined.
Material and method: A prospective study of 341 consecutive patients admitted to the conducted in the Clinic of Cardiology – Institute of Cardiovascular Diseases Tg Mures – from 31 Jan 08 to 31 Dec 10 with ST-segment elevation myocardial infarction. Patients underwent routine clinical exam, lab tests, echocardiogram.
Results: The incidence of atrial fibrillation complicating myocardial infarction was 11.6%. Statistically significant correlations were found between atrial fibrillation and age (p <0.001), smoking (p <0.01), and mitral regurgitation (p <0.05).
Conclusions: Post-MI AF is more common in older patients, in patients with heart failure, and after more extensive infarction. AF is a common complication of acute MI in smoking patients and in patients with significant mitral regurgitation.

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Attitudes and Preferred Information Sources in Medical Students and Family Doctors Regarding Organ Donation and Transplantation

Jung H1, Egyed-Zsigmond I2, Hecser L1, Brînzaniuc Klara3

1 Institute of Legal Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Anatomy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Organ transplantation is a modern treatment for many patients, however current organ shortage determines the need to identify strategies to eliminate barriers and increase organ donation rate. Aim of the study is to determine present and future health care professionals’ attitude and methods of further knowledge acquisition on the topic of organ donation and transplantation.
Material and method: We performed a cross-sectional survey in a study population consisting of preclinical medical undergraduates and of general practitioner doctors, the self administered questionnaires were anonymously statistically analyzed, the association between variables was considered significant for values p <0.05.
Results: One-hundred forty students and 48 doctors participated in our study, both groups showed positive attitude towards organ donation, 81.4% and 68.8% respectively were willing to donate own organs after death. Previous family discussions determined significant change of attitude among students but not within the group of doctors. Formal earlier education on the topic of transplantation was reported by 25% of the students but by none of the doctors. Preferred information channels are medical journal articles in both groups (37.9% vs. 35%), additionally medical students would prefer lectures and seminars while doctors would like to receive information during conferences and congresses. Internet is chosen (30–32%) over classical mass media.
Conclusions: although health care professionals have a natural inclination towards accepting donation and transplantation, providing information is essential in structuring their attitude in the way of promoting an environment that has a positive influence on organ donation rates.

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Assessment of the Level of Burnout in Several Medical Fields by Studying the Diurnal Profile of Salivary Cortisol

Ioniță Alexandrina1, Copotoiu Monica2, Hutan Adina3, Copotoiu Ruxandra4

1 Department of Anaesthesia and Intensive Care, County Hospital, Tîrgu Mureș, Romania
2 Clinic of Rheumatology, Emergency County Hospital, Tîrgu Mureș, Romania
3 University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Clinic of Anaesthesia and Intensive Care, Emergency County Hospital, Tîrgu Mureș, Romania

Background: Occupational stress afflicts not only job performance, but also the physical status and the health of the working human being. Thus, methods to analyze the level of stress and burnout by laboratory measurements and different types of questionnaires were developed during the last years.
Aim: To determine the relationship between salivary cortisol variations and the individual self evaluation performed by physicians in several medical fields: general surgery, intensive care, internal medicine.
Material and method: A self assessment survey was undertaken by physicians in three specialties, investigating the place doctors find themselves in the collectivity, their integration and interpersonal relationships – all contributing to a burn-out potential inventory score, the BPI. The BPI score was correlated with the cortisol level found in 3 samples of saliva collected at awakening, immediately after the maximum stress of the day and at night, before sleeping.
Results: We found significant variations of the cortisol level between the early morning salivary level at awakening and the climax of the stress. There was a linear correlation between the maximal cortisol level and the BPI score.
Conclusion: Salivary cortisol, well correlated with serum levels is a consistent marker of the stress and the intensity of the reactivity to stress. Thus we promote it as a feasible, accessible and low cost measurement of the reactivity to stress, both for the individual and the professional group.

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Improvement of Risk Stratification in Acute Lymphoblastic Leukemia Patients by the Determination of the BCR-ABL Gene Expression

Horváth Adrienne1, Baghiu Maria Despina1, Pávai Z2, Pap Zsuzsanna2, Chinceșan Mihaela1, Koncsag E1

1 Department of Pediatrics I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Morphopathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: The BCR-ABL fusion gene [t(9;22) (q34;q11)] occurs in 3–5% of pediatric acute lymphoblastic leukemia (ALL) and predicts a very poor prognosis.
Material and methods: 2 ml samples of bone marrow (BM) and peripheral blood (PB) in EDTA tubes from 24 ALL patients were examined in the molecular biology laboratory of our university with quantitative real-time PCR (qRT-PCR) method for BCR-ABL gene expression. Prognostic factors, like age, leucocyte count, lymphoblast morphology and immunology, absolute lymphoblast count on day 8, remission status on day 33 as well as treatment results were recorded from every patient.
Results: All 24 qRT-PCR analysis for major and minor BCR-ABL gene expression from BM and PB were negative. Immunophenotyping performed in 25 patients revealed common B ALL in 12 patients, T-cell immunology in 3 and pre-B immunophenotype with aberrant myeloid marker expression and/or CD10 negativity in 11 patients. L1 morphology appeared in 85.7% of the pre-B ALL cases, while other immunophenotypes were more likely associated with L2 cytology (62.5%) (p=0.033). Early cortisone response was favourable in 22 patients, all 26 patients achieved complete remission on day 33. Common B immunophenotype was associated with lower WBC (mean 37,770, median 8,200) than other immunophenotypes (WBC mean 63,783, median 50,680).
Conclusions: A new method, the qRT-PCR test was introduced in the investigation of pediatric ALL in our university from 2010. We found a statistically significant correlation between L1 blast morphology and common B immunophenotype. Poor cortisone response was found more frequently in T-cell ALL and pre-B ALL with aberrant myeloid markers or CD10 negativity. All our patients achieved complete remission on day 33. Lower WBC count at presentation was associated with L1 morphology and pre-B immunophenotype.

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Preliminary Results Regarding the New Changes in the 7th AJCC/UICC Staging System of Gastric Carcinomas

Hălmaciu Ioana1, Gurzu Simona2, Suciu BA3, Comişel SI4, Dénes L1, Boc Lacrima5, Brînzaniuc Klara1

1 Department of Anatomy and Embryology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureş Romania
3 Department of Surgery, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Department of Oral and Maxillofacial Surgery, Emergency County Hospital, Tîrgu Mureş, România
5 Student, University of University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objective: The aim of the study was to analyze in parallel the 6th and the newest 7th AJJCC/UICC (American Joint Committee on Cancer/ International Union Against Cancer) staging system in order to highlight changes brought about the new staging system.
Methods: We analyzed data obtained retrospectively from 134 hospitalized patients diagnosed with gastric carcinomas, who underwent surgery at the Surgery Clinic of the Emergency County Hospital of Tîrgu Mureş, Romania between 2008–2010. The data have been obtained from histopathology reports, and the analyzed parameters were the following: age, gender and pTNM staging. For all cases included in the study restaging was performed according to the 7th AJJCC/UICC staging system. For statistical analysis we used GraphPad InStat software.
Results: 71.66% of cases were adenocarcinomas, 7.46% mucinous adenocarcinoma, 14.17% signet ring cell carcinoma, and 6.71% undifferentiated carcinoma. The signet ring cell carcinomas predominated before 65 years of age (p=0.003). Compared to the 6th staging system, in the new system, pT2 percentages decreased significantly from 38.8% to 6.71%, and pT4 increases from 11.19% to 55.97% (p<0.0001).The pN3 cases increased from 20.9% to 45.52%, because all cases classified as pN2 in the old staging system, become pN3 in the new system. Some of pN1 cases turned into pN2 in the new system (p=0.004). The stage IV cases also decreased from 29.85% to 14.94%, due to regrouping of stage III.
Conclusions: There are significant changes between the two staging systems. The new staging system aims to achieve a better postoperative follow-up.

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Multimarker Phenotypes of Colorectal Cancer

Gurzu Simona1, Jung I1, Szakács Orsolya2, Csernák Erzsébet2, Tóth Erika2, Popa D3, Szentirmay Z2

1 Department of Pathology, University of Medicine and Pharmacy of Tîrgu Mureş, Romania
2 Department of Pathology and Molecular Biology, National Institute of Oncology, Budapest, Hungary
3 Department of Anatomy and Embryology, University of Medicine and Pharmacy of Tîrgu Mureş, Romania

Objective: We tried to correlate the clinico-pathologically features of colorectal cancer (CRC) to expression of eight immunohistochemically (IHC) markers and microsatellite instability (MSI) in order to realyze a molecular subdivision of these tumors.
Methods: 300 CRC, surgical specimens, were statistically and IHC evaluated. MSI status was analyzed in 52 cases, with Real Time PCR, melting point analysis. The following IHC markers have been used: CD8, E-cadherin, HER-2, p53, Ki67, bcl-2, MLH-1, CEA. The molecular phenotypes have been reported to the node status (pN) and MSI.
Results: Based on statistically analyses, we revealed that CEA and Ki67 were not prognostic factors. MLH-1 may indicate the MSI status and the number of tumor inflitrated lymphocytes stained with CD8 seems to be higher in the MSI cases and tumors of the proximal colon. HER-2 expression was correlated to number of the lymph node metastatses and bcl-2 was negative is most of the CRC diagnosed in advanced stages.
Conclusions: The CRC may be subdivided in six molecular prognostic groups, the best prognosis showing the MSI/p53-/bcl-2+/HER-2- and the worst MSS/p53+/bcl-2±/HER-2+. These molecular subdivision may be the basis for targeted therapy in node negative CRC.

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